Preserving wellbeing for the chronically ill

Aiding wellbeing among people with chronic pain during the pandemic

Chronic pain populations can be disproportionately impacted by public health restrictions during a pandemic. Consequently, it is important to maintain access to essential non-urgent support services during periods of lockdown in order to preserve wellbeing in this population, a new study recommends.
ZOË ZAMBELLI reports.

AMONG chronic pain populations, the decreased ability to self-manage pain, restricted access to healthcare and increased dependence on others are found to be associated with negative wellbeing outcomes related to sleep, anxiety and depression. A study funded by the Economic and Social Research Council examined the experiences of these individuals during recent periods of lockdown with a view to mitigating risk in future waves where possible.

There is clear evidence that selfmanagement strategies play an important role for psychological coping and management of chronic pain. These strategies include adhering to prescribed medication or physical activity regimen, identifying treatments jointly with a health practitioner, in addition to managing the impact on mood and relationships due to pain interference.

Losing the ability to self-manage or restricting healthcare access for prolonged periods may have a significant impact on wellbeing, including sleep behaviours and mental health. The pandemic brings risk and burden to chronic pain populations regarding disease management, as well as the potential to impact social and health behaviours.

Evidence also suggests that socioeconomic status (SES) may influence self-management outcomes as those with low SES may have access to fewer resources than those with high SES. Additionally, access to healthcare greatly impacts an individual’s health journey as those with chronic pain rely on a combination of assessments, diagnostics, and interventions, involving frequent interaction with the health system.

The objective of the study was to explore changes in wellbeing outcomes as related to sleep, anxiety and depression within a community sample of adults living with chronic pain between the start of the Covid-19 outbreak, pre-lockdown and during a period of lockdown in the UK.

Respondents’ chronic pain conditions were grouped into seven types, including chronic widespread pain (eg fibromyalgia; 34%), musculoskeletal (eg osteoarthritis; 37%), headache (eg chronic migraine; 10%), visceral (eg pelvic pain; 3%), neuropathic (eg trigeminal neuralgia; 15%) and other (1%). Nearly all participants reported co-existing physical health conditions (95%), and more than half reported a mental health condition (55%).

The results demonstrated that individuals who felt less dependent on others had fewer sleep problems, anxiety, and depressive symptoms compared to those who reported feeling more dependent on others for practical and emotional support during this time.

Chronic pain poses a threat to individuals’ perceived independence, and research shows the importance of retaining independence in order to carry out activities of daily living and social interactions.

The study’s findings highlight the importance of maintaining access to health and care services as part of the wider care management plan for many with chronic pain

Recommendations

The study highlights implications related to psychosocial wellbeing, workforce and healthcare practice along with practical recommendations which should be considered in the current climate.

Firstly, it is clear that the lockdown measures implemented during the first wave of Covid-19 have impacted communities and support for special populations. The research shows the importance of retained independence on mental health in chronic pain populations. It is foreseen that future lockdowns would cause a social disconnection and a threat of increased loneliness. Thus, it is recommended that considerations are made for allowing social “bubbles” and social cohesion to continue in support for chronic pain communities during future public health restrictions.

Secondly, a significant proportion of the UK workforce is affected by chronic pain and disability across all sectors and skills bases who contribute greatly to the economy. It is therefore vital to ensure this portion of the workforce can continue their contribution while managing the increased risk of disease severity as a result of Covid-19. Workplace managers (supported by policies to protect workers’ rights) should carry out necessary risk assessment and ensure that individuals most at risk can contribute via adaptable working plans, whether through remote working or redeployment, before taking steps to prevent individuals from working in any capacity.

Thirdly, there is evidence that closure of non-urgent health services has impacted waitlists as they begin to reopen. It is therefore recommended that services which begin to triage backlogs of cases based on clinical need ensure referral pathways to psychological and mental health services are in place. There is evidence that mental health has suffered because of halted health and social care services and it is reasonable to assume that once financial assistance programmes come to an end (such as furlough schemes), many more will be in need of these services.

Identifying factors which could impact wellbeing in this population may help health and social care services dealing with the pandemic’s response and recovery process. Research and learnings from the Covid-19 outbreak should be used to inform policy and emergency planning responses for future pandemics. Policymakers should consult with a wide range of professionals such as healthcare, social workers and third sector workers to plan local strategies which meet individual as well as collective needs within the population.