DOI QR코드

DOI QR Code

Impact of coronavirus disease 2019 on patients with chronic pain: multicenter study in Korea

  • John, Hyunji (Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine) ;
  • Lim, Yun Hee (Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital) ;
  • Hong, Sung Jun (Department of Anesthesiology and Pain Medicine, Hallym University Kangdong Sacred Heart Hospital) ;
  • Jeong, Jae Hun (Department of Anesthesiology and Pain Medicine, Jeong-clinic) ;
  • Choi, Hey Ran (Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital) ;
  • Park, Sun Kyung (Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine) ;
  • Kim, Jung Eun (Department of Anesthesiology and Pain Medicine, Hallym University Kangnam Sacred Heart Hospital) ;
  • Kim, Byung-soo (Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine) ;
  • Kim, Jae Hun (Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine)
  • Received : 2021.11.05
  • Accepted : 2021.12.31
  • Published : 2022.04.01

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has caused significant changes. This study aimed to investigate the impact of COVID-19 on patients with chronic pain. Methods: Patients with chronic pain from 23 university hospitals in South Korea participated in this study. The anonymous survey questionnaire consisted of 25 questions regarding the following: demographic data, diagnosis, hospital visit frequency, exercise duration, time outside, sleep duration, weight change, nervousness and anxiety, depression, interest or pleasure, fatigue, daily life difficulties, and self-harm thoughts. Depression severity was evaluated using the Patient Health Questionnaire-9 (PHQ-9). Logistic regression analysis was used to investigate the relationship between increased pain and patient factors. Results: A total of 914 patients completed the survey, 35.9% of whom had decreased their number of visits to the hospital, mostly due to COVID-19. The pain level of 200 patients has worsened since the COVID-19 outbreak, which was more prominent in complex regional pain syndrome (CRPS). Noticeable post-COVID-19 changes such as exercise duration, time spent outside, sleep patterns, mood, and weight affected patients with chronic pain. Depression severity was more significant in patients with CRPS. The total PHQ-9 average score of patients with CRPS was 15.5, corresponding to major depressive orders. The patients' decreased exercise duration, decreased sleep duration, and increased depression were significantly associated with increased pain. Conclusions: COVID-19 has caused several changes in patients with chronic pain. During the pandemic, decreased exercise and sleep duration and increased depression were associated with patients' increasing pain.

Keywords

References

  1. Karos K, McParland JL, Bunzli S, Devan H, Hirsh A, Kapos FP, et al. The social threats of COVID-19 for people with chronic pain. Pain 2020; 161: 2229-35. https://doi.org/10.1097/j.pain.0000000000002004
  2. Holmes EA, O'Connor RC, Perry VH, Tracey I, Wessely S, Arseneault L, et al. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry 2020; 7: 547-60. https://doi.org/10.1016/s2215-0366(20)30168-1
  3. Choi EPH, Hui BPH, Wan EYF. Depression and anxiety in Hong Kong during COVID-19. Int J Environ Res Public Health 2020; 17: 3740. https://doi.org/10.3390/ijerph17103740
  4. Killgore WDS, Cloonan SA, Taylor EC, Dailey NS. Loneliness: a signature mental health concern in the era of COVID-19. Psychiatry Res 2020; 290: 113117. https://doi.org/10.1016/j.psychres.2020.113117
  5. Shah SMA, Mohammad D, Qureshi MFH, Abbas MZ, Aleem S. Prevalence, psychological responses and associated correlates of depression, anxiety and stress in a global population, during the Coronavirus Disease (COVID-19) pandemic. Community Ment Health J 2021; 57: 101-10. https://doi.org/10.1007/s10597-020-00728-y
  6. Petzold MB, Bendau A, Plag J, Pyrkosch L, Mascarell Maricic L, Betzler F, et al. Risk, resilience, psychological distress, and anxiety at the beginning of the COVID-19 pandemic in Germany. Brain Behav 2020; 10: e01745.
  7. Griffin KM, Karas MG, Ivascu NS, Lief L. Hospital preparedness for COVID-19: a practical guide from a critical care perspective. Am J Respir Crit Care Med 2020; 201: 1337-44. https://doi.org/10.1164/rccm.202004-1037cp
  8. MacIntyre CR, Wang Q. Physical distancing, face masks, and eye protection for prevention of COVID-19. Lancet 2020; 395: 1950-1. Erratum in: Lancet 2020; 395: 1972. https://doi.org/10.1016/S0140-6736(20)31323-4
  9. Hruschak V, Flowers KM, Azizoddin DR, Jamison RN, Edwards RR, Schreiber KL. Cross-sectional study of psychosocial and pain-related variables among patients with chronic pain during a time of social distancing imposed by the coronavirus disease 2019 pandemic. Pain 2021; 162: 619-29. https://doi.org/10.1097/j.pain.0000000000002128
  10. Park GE, Ko JH, Peck KR, Lee JY, Lee JY, Cho SY, et al. Control of an outbreak of Middle East respiratory syndrome in a tertiary hospital in Korea. Ann Intern Med 2016; 165: 87-93. https://doi.org/10.7326/m15-2495
  11. Hammig O. Health risks associated with social isolation in general and in young, middle and old age. PLoS One 2019; 14: e0219663. Erratum in: PLoS One 2019; 14: e0222124. https://doi.org/10.1371/journal.pone.0222124
  12. Mogil JS. Social modulation of and by pain in humans and rodents. Pain 2015; 156 Suppl 1: S35-41. https://doi.org/10.1097/01.j.pain.0000460341.62094.77
  13. Karayannis NV, Baumann I, Sturgeon JA, Melloh M, Mackey SC. The impact of social isolation on pain interference: a longitudinal study. Ann Behav Med 2019; 53: 65-74. https://doi.org/10.1093/abm/kay017
  14. Jeong S, An J, Cho S. Role of affective instability on suicidal risk in complex regional pain syndrome: a diary approach (preliminary report). Korean J Pain 2021; 34: 94-105. https://doi.org/10.3344/kjp.2021.34.1.94
  15. Blyth FM, March LM, Brnabic AJ, Cousins MJ. Chronic pain and frequent use of health care. Pain 2004; 111: 51-8. https://doi.org/10.1016/j.pain.2004.05.020
  16. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16: 606-13. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
  17. Ford J, Thomas F, Byng R, McCabe R. Use of the Patient Health Questionnaire (PHQ-9) in practice: interactions between patients and physicians. Qual Health Res 2020; 30: 2146-59. https://doi.org/10.1177/1049732320924625
  18. Levis B, Benedetti A, Thombs BD; DEPRESsion Screening Data (DEPRESSD) Collaboration. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ 2019; 365: l1476. Erratum in: BMJ 2019; 365: l1781.
  19. Park KY. Reliability, validity and clinical usefulness of the Korean version of the Patient Health Questionnaire-9 (PHQ9). Glob Health Nurs 2017; 7: 71-8.
  20. Levis B, Sun Y, He C, Wu Y, Krishnan A, Bhandari PM, et al. Accuracy of the PHQ-2 alone and in combination with the PHQ-9 for screening to detect major depression: systematic review and meta-analysis. JAMA 2020; 323: 2290-300. https://doi.org/10.1001/jama.2020.6504
  21. Manea L, Gilbody S, McMillan D. A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. Gen Hosp Psychiatry 2015; 37: 67-75. https://doi.org/10.1016/j.genhosppsych.2014.09.009
  22. Mak IW, Chu CM, Pan PC, Yiu MG, Chan VL. Long-term psychiatric morbidities among SARS survivors. Gen Hosp Psychiatry 2009; 31: 318-26. https://doi.org/10.1016/j.genhosppsych.2009.03.001
  23. Galer BS, Henderson J, Perander J, Jensen MP. Course of symptoms and quality of life measurement in Complex Regional Pain Syndrome: a pilot survey. J Pain Symptom Manage 2000; 20: 286-92. https://doi.org/10.1016/S0885-3924(00)00183-4
  24. Li LW, Chew AMK, Gunasekeran DV. Digital health for patients with chronic pain during the COVID-19 pandemic. Br J Anaesth 2020; 125: 657-60. https://doi.org/10.1016/j.bja.2020.08.003
  25. Consonni M, Telesca A, Grazzi L, Cazzato D, Lauria G. Life with chronic pain during COVID-19 lockdown: the case of patients with small fibre neuropathy and chronic migraine. Neurol Sci 2021; 42: 389-97. https://doi.org/10.1007/s10072-020-04890-9
  26. Savas S, Baloglu HH, Ay G, Cerci SS. The effect of sequel symptoms and signs of Complex Regional Pain Syndrome type 1 on upper extremity disability and quality of life. Rheumatol Int 2009; 29: 545-50. https://doi.org/10.1007/s00296-008-0748-8
  27. Lee J, Lim YH, Hong SJ, Jeong JH, Choi HR, Park SK, et al. Multicenter survey of symptoms, work life, economic status, and quality of life of complex regional pain syndrome patients. Korean J Pain 2021; 34: 288-303. https://doi.org/10.3344/kjp.2021.34.3.288
  28. Geertzen JH, Dijkstra PU, van Sonderen EL, Groothoff JW, ten Duis HJ, Eisma WH. Relationship between impairments, disability and handicap in reflex sympathetic dystrophy patients: a long-term follow-up study. Clin Rehabil 1998; 12: 402-12. https://doi.org/10.1191/026921598676761735
  29. Velavan TP, Meyer CG. The COVID-19 epidemic. Trop Med Int Health 2020; 25: 278-80. https://doi.org/10.1111/tmi.13383
  30. Moraes EN, Viana LG, Resende LMH, Vasconcellos LS, Moura AS, Menezes A, et al. COVID-19 in long-term care facilities for the elderly: laboratory screening and disease dissemination prevention strategies. Cien Saude Colet 2020; 25: 3445-58. https://doi.org/10.1590/1413-81232020259.20382020
  31. Huang Y, Wang Y, Zeng L, Yang J, Song X, Rao W, et al. Prevalence and correlation of anxiety, insomnia and somatic symptoms in a Chinese population during the COVID-19 epidemic. Front Psychiatry 2020; 11: 568329. https://doi.org/10.3389/fpsyt.2020.568329
  32. Zhai L, Zhang H, Zhang D. Sleep duration and depression among adults: a meta-analysis of prospective studies. Depress Anxiety 2015; 32: 664-70. https://doi.org/10.1002/da.22386
  33. Schuh-Hofer S, Wodarski R, Pfau DB, Caspani O, Magerl W, Kennedy JD, et al. One night of total sleep deprivation promotes a state of generalized hyperalgesia: a surrogate pain model to study the relationship of insomnia and pain. Pain 2013; 154: 1613-21. https://doi.org/10.1016/j.pain.2013.04.046
  34. Xu Z, Su H, Zou Y, Chen J, Wu J, Chang W. Sleep quality of Chinese adolescents: distribution and its associated factors. J Paediatr Child Health 2012; 48: 138-45. https://doi.org/10.1111/j.1440-1754.2011.02065.x
  35. Kim SH, Sun JM, Yoon KB, Moon JH, An JR, Yoon DM. Risk factors associated with clinical insomnia in chronic low back pain: a retrospective analysis in a university hospital in Korea. Korean J Pain 2015; 28: 137-43. https://doi.org/10.3344/kjp.2015.28.2.137
  36. O'Donoghue GM, Fox N, Heneghan C, Hurley DA. Objective and subjective assessment of sleep in chronic low back pain patients compared with healthy age and gender matched controls: a pilot study. BMC Musculoskelet Disord 2009; 10: 122. https://doi.org/10.1186/1471-2474-10-122
  37. Kelly GA, Blake C, Power CK, O'Keeffe D, Fullen BM. The association between chronic low back pain and sleep: a systematic review. Clin J Pain 2011; 27: 169-81. https://doi.org/10.1097/AJP.0b013e3181f3bdd5
  38. Lee HJ, Choi EJ, Nahm FS, Yoon IY, Lee PB. Prevalence of unrecognized depression in patients with chronic pain without a history of psychiatric diseases. Korean J Pain 2018; 31: 116-24. https://doi.org/10.3344/kjp.2018.31.2.116
  39. Bair MJ, Wu J, Damush TM, Sutherland JM, Kroenke K. Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients. Psychosom Med 2008; 70: 890-7. https://doi.org/10.1097/psy.0b013e318185c510
  40. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med 2003; 163: 2433-45. https://doi.org/10.1001/archinte.163.20.2433
  41. Ten Brink AF, Peters L, Kompouli PI, Jordan A, McCabe CS, Goebel A, et al. Bodily changes and sensory sensitivity in complex regional pain syndrome and fibromyalgia. Pain 2020; 161: 1361-70. https://doi.org/10.1097/j.pain.0000000000001830
  42. Chan DX, Lin XF, George JM, Liu CW. Clinical challenges and considerations in management of chronic pain patients during a COVID-19 pandemic. Ann Acad Med Singap 2020; 49: 669-73. https://doi.org/10.47102/annals-acadmedsg.2020130
  43. Lassen CL, Siam L, Degenhart A, Klier TW, Bundscherer A, Lindenberg N. Short-term impact of the COVID-19 pandemic on patients with a chronic pain disorder. Medicine (Baltimore) 2021; 100: e25153. https://doi.org/10.1097/MD.0000000000025153
  44. O'Brien EM, Waxenberg LB, Atchison JW, Gremillion HA, Staud RM, McCrae CS, et al. Intraindividual variability in daily sleep and pain ratings among chronic pain patients: bidirectional association and the role of negative mood. Clin J Pain 2011; 27: 425-33. https://doi.org/10.1097/AJP.0b013e318208c8e4
  45. Gilan D, Rothke N, Blessin M, Kunzler A, Stoffers-Winterling J, Mussig M, et al. Psychomorbidity, resilience, and exacerbating and protective factors during the SARS-CoV-2 pandemic. Dtsch Arztebl Int 2020; 117: 625-30.
  46. Serrano-Ibanez ER, Esteve R, Ramirez-Maestre C, RuizParraga GT, Lopez-Martinez AE. Chronic pain in the time of COVID-19: stress aftermath and central sensitization. Br J Health Psychol 2021; 26: 544-52. https://doi.org/10.1111/bjhp.12483
  47. Sim K, Huak Chan Y, Chong PN, Chua HC, Wen Soon S. Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease. J Psychosom Res 2010; 68: 195-202. https://doi.org/10.1016/j.jpsychores.2009.04.004
  48. Park SJ, Choi HR, Choi JH, Kim K, Hong JP. Reliability and validity of the Korean version of the Patient Health Questionnaire-9 (PHQ-9). Anxiety Mood 2010; 6: 119-24.